ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Shafik, A.
Right arrow Articles by Mostafa, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Shafik, A.
Right arrow Articles by Mostafa, R.
Related Collections
Right arrow Esophagus - other

Ann Thorac Surg 2005;79:1126-1131
© 2005 The Society of Thoracic Surgeons

Original articles: General thoracic

Effect of Lower Esophageal Sphincter Distension and Acidification on Esophageal Pressure and Electromyographic Activity: The Identification of the "Sphinctero-Esophageal Excitatory Reflex"

Ahmed Shafik, MD, PhDa,*, Ismail Shafik, MD, MCha, Olfat El-Sibai, MD, PhDb, Randa Mostafa, MD, PhDc

a Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt
b Department of Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
c Department of Physiology, Faculty of Medicine, Zagazig University, Benha, Egypt

Accepted for publication September 27, 2004.

* Address reprint requests to Dr A. Shafik, 2 Talaat Harb Street, Cairo, 11121, Egypt (E-mail: shafik{at}ahmed-shafik.org).

BACKGROUND: The mechanism of esophageal acid clearance through augmenting esophageal peristalsis in response to gastroesophageal reflux (GER) is not exactly known. We investigated the hypothesis that lower esophageal sphincter (LES) dilatation rather than the refluxed acid affected reflex increase in the esophageal peristaltic activity aiming at clearing the esophagus of the refluxed acid.

METHODS: The esophageal pressure and electromyographic (EMG) activity response to esophageal sphincter balloon distension in increments of 2 mL of saline was recorded in 17 healthy volunteers (10 men, 7 women, mean age 43.6 ± 11.2 years). The test was repeated in 10 of 17 volunteers while the esophageal sphincter was being anesthetized. The response of the esophageal pressure and electromyographic activity to lower esophageal acidification was also tested.

RESULTS: Lower esophageal sphincter balloon distension with 2 mL of saline produced esophageal pressure increase to a mean of 34.2 ± 5.3 cm H2O (p < 0.001). Increase of the balloon distending volume produced results similar to the 2-mL distension (p > 0.05). The esophageal electrical activity increased on esophageal balloon distension; the increase was similar with distensions of 2 mL up to 10 mL. There was no esophageal pressure or electrical activity response to distension of the anesthetized lower esophageal sphincter or to lower esophageal sphincter acidification.

CONCLUSIONS: During gastroesophageal reflux episodes, the lower esophageal sphincter dilatation and not acidification appears to initiate increased esophageal peristalsis, which clears the esophagus of the refluxed acid. The increased esophageal peristalsis on lower esophageal sphincter dilatation is suggested to be reflex in nature and is mediated through the "sphincteroesophageal excitatory reflex." This reflex may be of diagnostic significance in esophageal motility disorders; however, this point needs further studies.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2005 by The Society of Thoracic Surgeons.